Provider Demographics
NPI:1811517881
Name:FORNARA, MELISSA B (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:FORNARA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:B
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:1015 GARDEN OF THE GODS RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3489
Mailing Address - Country:US
Mailing Address - Phone:719-354-5297
Mailing Address - Fax:
Practice Address - Street 1:1015 GARDEN OF THE GODS RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3489
Practice Address - Country:US
Practice Address - Phone:719-354-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist